Cleveland Clinic (Thakar) Score, Dialysis-Requiring ARF After Cardiac Surgery
The Cleveland Clinic score (Thakar and colleagues, JASN 2005) for the preoperative risk of acute renal failure requiring dialysis after cardiac surgery.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Female
- Yes
- Congestive heart failure
- No
- Left ventricular ejection fraction under 35 percent
- No
- Preoperative intra-aortic balloon pump
- No
- Chronic obstructive pulmonary disease
- No
- Diabetes requiring insulin
- No
- Previous cardiac surgery
- No
- Emergency surgery
- No
- Type of cardiac surgery
- Valve only
- Preoperative serum creatinine
- 1.5 mg/dL
Result: Thakar) score 4 of 17.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Outcome
- Acute renal failure REQUIRING DIALYSIS, not KDIGO AKI. That distinction drives most confusion.
- Surgery
- CABG 0; valve 1; CABG+valve 2; OTHER 2. Not ordered by invasiveness.
- Creatinine
- Under 1.2 = 0; 1.2 to under 2.1 = 2; 2.1 or above = 5. Stepped, never interpolated.
- Categories
- 0-2, 3-5, 6-8, 9-13. The score runs to 17, so 14-17 are reachable and UNCLASSIFIED.
- Rates
- The exact percentages are NOT quoted: sources disagree and the primary table is paywalled.
- Scope
- A preoperative estimate for one complication. Not an indication to cancel or defer surgery.
What you enter
- Female.
- Congestive heart failure.
- Left ventricular ejection fraction under 35 percent.
- Preoperative intra-aortic balloon pump.
- Chronic obstructive pulmonary disease.
- Diabetes requiring insulin.
- Previous cardiac surgery.
- Emergency surgery.
- Type of cardiac surgery.
- Preoperative serum creatinine.
Full field descriptions
- Female. 1 point. Preoperative.
- Congestive heart failure. 1 point. Preoperative.
- Left ventricular ejection fraction under 35 percent. 1 point. Preoperative.
- Preoperative intra-aortic balloon pump. 2 points. Preoperative.
- Chronic obstructive pulmonary disease. 1 point. Preoperative.
- Diabetes requiring insulin. 1 point. Preoperative.
- Previous cardiac surgery. 1 point. Preoperative.
- Emergency surgery. 2 points. Preoperative.
- Type of cardiac surgery. NOT ordered by invasiveness: "other" scores the same as CABG plus valve, and isolated CABG scores 0 [cabg = Coronary artery bypass grafting only, 0 points; valve = Valve only, 1 points; cabg-valve = CABG plus valve, 2 points; other = Other cardiac surgery, 2 points]
- Preoperative serum creatinine. A STEPPED term, never interpolated: Under 1.2 mg/dL = 0 points; 1.2 to under 2.1 mg/dL = 2 points; 2.1 mg/dL or above = 5 points. The 2 to 5 jump is larger than any single risk factor.
How this is calculated
- Weights
- Female 1, CHF 1, EF<35% 1, IABP 2, COPD 1, insulin diabetes 1, prior cardiac surgery 1, emergency 2.
Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16(1):162-168. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.